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General NPI Number Information
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NPI Number | 1750683694
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Entity Type | Organization
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Legal Business Name | CHARIS FOUNDATION INC
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Dates
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Enumeration Date | 11/29/2010
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Last Update Date | 11/29/2010
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Provider Practice Location Address
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Address Line | 9621 SIX FORKS RD
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City | RALEIGH
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State | NC
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Zip | 27615-1628
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Country | US
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Telephone | 919-671-4374
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Fax |
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Provider Business Mailing Address
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Address Line | 7716 FALL BRANCH CT
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City | WAKE FOREST
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State | NC
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Zip | 27587-8719
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Country | US
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Telephone | 919-556-9141
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Fax |
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Authorized Official
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Title or Position | FOUNDER
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Name | FRANK GREEN
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Credential | D.MIN, LMFT
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Telephone | 919-556-9141
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 488
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 3964
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License Number State | NC
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